This is a proposal to refine and evaluate a new technology designed to improve hypertension care, at less than the current cost. Hypertension is one of the commonest medical conditions, affecting about heart disease. It cost about $18.7 billion to treat hypertension in the US in 1995. Despite the large number of effective antihypertensive drugs, and clear evidence that their use can reduce morbidity associated with hypertension, only an estimated one in four Americans with high blood pressure has it well controlled. This is a proposal to integrate a clinical-grade electronic home blood pressure monitor with a very low-cost proprietary teletransmission system which we have developed, to enable patients to easily send blood pressure and heart rate data to physicians over ordinary telephone lines. These user-friendly technologies will be imbedded in an automated information management system which will shift the site of care from clinic to home, and improve the ability of both physicians and patients to assess and manage hypertension. We project a $5/month cost to the user for the entire system, including monitor and telecommunications. PROPOSED COMMERCIAL APPLICATION: Our service will allow managed care companies to reduce the cost of treating hypertension by improving patient compliance with therapy, cutting unneeded care for people with White Coat hypertension (high blood pressure only in the MD's office, estimated at 20% of patients), identifying noncompliant or poorly-controlled patients, and shifting the site of care from MD's office to patient's home. Our initial market: group-staff HMOs (15 million covered lives, 1.25 million hypertensives).